Raising expectations and improving employment support

By Kate Green MP

Like any MP, I’ve had my share of constituents coming to see me about problems with their work capability assessment (WCA) for employment and support allowance (ESA). Some of those who come to me are initially quite hesitant to tell me what’s gone wrong. Gradually, they open up – they’re suffering from mental illness, but they don’t like to speak about it. When they’ve been called for an assessment , they’re frightened and unsure what to do. Some go along, but can’t explain their condition properly to the assessor, or the assessor lacks expertise in mental health conditions. Others simply fail to turn up, and lose benefits as a result.There shouldn’t be a stigma to talking about mental health, but there certainly is, and that’s true whether you’re working, or you’re too ill to work. Yet although one in four adults will experience mental illness, we hardly talk about it at all.

I’m very concerned that the WCA is proving so poor at identifying people with mental illnesses properly. Not only does this mean some claimants are wrongly being expected to be available to work when they’re too ill to do so, but for those claimants who could work or be preparing for work, the system simply isn’t identifying the support that they need.

The Work Programme has been performing exceptionally poorly for sick and disabled people, with a 95% failure rate – worse than if no programme was running at all. And Work Choice too has a poor record, with only around one in eight of those on the programme with mild to moderate mental health problems moving into work.

Nor are our health services or healthcare professionals well attuned to supporting people to get back into or stay in employment – yet in many cases, people’s recovery would be helped by being able to stay in good quality, stable work. Instead, many fall into a downward spiral of unemployment, anxiety and depression, worrying about the future, about losing income, and how they’ll cope.

Employers meanwhile feel ill-equipped to employ people with a history of mental illness – yet they almost certainly already have employees in their workplace who’ve experienced problems with mental health.

Of course, we need an assessment process to determine the level of support people need, but it has to be one that is more attuned to both the needs and capabilities of those experiencing mental health problems. But it’s also clear we need a whole-system focus on improving the employment chances and experiences of those with mental health conditions, offering more personalised support, tailor-made interventions, a better assessment process, the systematic engagement of health workers and commissioners, better workplace support and information for employers.

Yet, although everybody knows this, expectations remain low. But the cost to individuals, and to society, surely makes it an imperative. Raising the employment rate for those with mental health problems to something near to that of the general population would have a huge positive impact on our economy, and on the economic wellbeing of thousands of individuals on benefits.

In my role as Labour’s spokesperson for disabled people, I’m beginning to think very carefully about how we can improve employment outcomes for sick and disabled people for whom work would be possible, and how the system, whether that’s the WCA, Work Programme and Access to Work, healthcare support provided by the NHS, or a more flexible and responsive workplace, needs to change. I’m especially interested to hear ideas about the changes that we need to make for people with mental health problems from employers, employees and healthcare workers, as well as employment specialists. I very much hope the Centre for Mental Health can take a leading role in helping to develop the thinking we need.

Risk, Safety and Recovery argues that risk and safety are rightly major concerns in mental health care but that traditional clinical management methods of assessing risk have stood in the way of helping people to recover their lives.

Perinatal mental health problems carry a total cost to society of about £8.1 billion for each one-year cohort of births in the UK. But the NHS would need to spend just £337 million a year to bring perinatal mental health care up to the recommended level.